QuestionIs cumulative exposure to residential segregation in young adulthood associated with midlife cognitive performance among black individuals in the US?

FindingsThis cohort study of 1568 black participants in the Coronary Artery Risk Development in Young Adults study found that relative to living in low-segregation neighborhoods, black participants who were exposed to highly segregated neighborhoods in young adulthood exhibited worse performance in processing speed.

MeaningThe findings suggest that cumulative exposure to residential segregation is associated with poor cognitive performance among black individuals as early as midlife, which may explain black-white disparities in dementia risk at older age.

Abstract

ImportanceNeighborhood-level residential segregation is implicated as a determinant for poor health outcomes in black individuals, but it is unclear whether this association extends to cognitive aging, especially in midlife.

ObjectiveTo examine the association between cumulative exposure to residential segregation during 25 years of young adulthood among black individuals and cognitive performance in midlife.

Design, Setting, and ParticipantsThe ongoing prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) Study recruited 5115 black and white participants aged 18 to 30 years from 4 field centers at the University of Alabama, Birmingham; University of Minnesota, Minneapolis; Northwestern University, Chicago, Illinois; and Kaiser Permanente, Oakland, California. Data were acquired from February 1985 to May 2011. Among the surviving CARDIA cohort, 3671 (71.8%) attended examination year 25 of the study in 2010, when cognition was measured, and 3008 (81.9%) of those completed the cognitive assessments. To account for time-varying confounding and differential censoring, marginal structural models using inverse probability weighting were applied. Data were analyzed from April 16 to July 20, 2019.

Main Outcomes and MeasuresRacial residential segregation was measured using the Getis-Ord Gi* statistic, and the mean cumulative exposure to segregation was calculated across 6 follow-up visits from baseline to year 25 of the study, then categorized into high, medium, and low segregation. Cognitive function was measured at year 25 of the study, using the Digit Symbol Substitution Test (DSST), Stroop color test (reverse coded), and Rey Auditory Verbal Learning Test. To facilitate comparison of estimates, z scores were calculated for all cognitive tests.

ResultsA total of 1568 black participants with available cognition data were included in the analysis. At baseline, participants had a mean (SD) age of 25 (4) years and consisted of 936 women (59.7%). Greater cumulative exposure to segregated neighborhoods was associated with a worse DSST z score (for high segregation, β = −0.37 [95% CI, −0.61 to −0.13]; for medium segregation, β = −0.25 [95% CI, −0.51 to 0.0002]) relative to exposure to low segregation.

Conclusions and RelevanceIn this cohort study, exposure to residential segregation throughout young adulthood was associated with worse processing speed among black participants as early as in midlife. This association may potentially explain black-white disparities in dementia risk at older age.